Groundbreaking Weight Loss Weapons and Expert Tips: Wheres the Magic Bullet?

Where's the Magic Bullet?

For the past 20 years, as Americans steadily gained weight, experts have searched for ways to reverse the trend. The reasons we gain and lose are complicated, they've learned, and involve more than just diet and exercise.

Drugs can help, of course. Two are currently approved for long-term use: Meridia works in the brain to suppress appetite; Xenical blocks the absorption of fat -- with unpleasant gastrointestinal side effects for some. And there's surgery, which is increasingly done laparoscopically but still has risks. We're all hoping, though, for a magic bullet. Biotech and pharma companies are spending millions to develop more powerful pills, gadgets and procedures to put an end to the condition that can trigger a host of serious diseases -- obesity.

This quest isn't easy. "We're finding that many behaviors we don't think of as genetic often have a genetic basis," says Susan Yanovski, MD, an obesity expert at the National Institute of Diabetes and Digestive and Kidney Diseases. "Some people get hungrier sooner than others; some fill up less quickly." Some binge; others are emotional eaters. And as more research is done, specific treatments may be discovered to deal with the various causes of obesity.

"The future is really bright for the development of better, safer and effective drugs," says Dr. Yanovski. "We're going to have more choices to treat obesity. And they'll be more specific, so you can target the medication to the patient, as we do in the treatment of high blood pressure." Here, some of the most exciting advances.

The Get-Thin Pill

Ask doctors what their biggest hope is for the near future and many will Home in on rimonabant. Sanofi-Aventis, the pill's maker, is awaiting FDA approval; the drug is already available in Europe. Rimonabant stifles hunger and cravings by targeting the endocannabinoid system, which plays a role in regulating weight. Cannabinoid receptors throughout the body are thought to stimulate cravings; rimonabant blocks the receptors, knocking out cravings. It also lowers triglycerides and improves HDL cholesterol.

Experts are excited about the drug, but agree it won't be a cure-all. "You can eat your way through rimonabant -- and all obesity treatments," says Mehmet C. Oz, MD, director of the Cardiovascular Institute at Columbia University Medical Center in New York City and co-author of You: On a Diet. On the other hand, one study found that following a healthy diet and exercising, in conjunction with obesity drugs, made them more effective.

Plus, you can't just take a pill, lose the weight and stop. "You've got to take obesity medications for a long time, if not for life," says Samuel Klein, MD, director of the Center for Human nutrition at Washington University School of Medicine in St. Louis. "You don't lower your blood pressure with medication and then say, 'Okay, now I'm going to stop.' If you lose weight and stop the treatment, it will bounce right back up again. That's been proved over and over again."

In any case, obesity drugs are reserved for people with a body mass index (BMI) of 30 and above, or a BMI of 27 or higher with Diabetes, high blood pressure or another complication of obesity. They're not for the "gotta lose those last ten pounds" dieter. And a review of studies found that rimonabant usually only leads to an 11-pound weight loss a year on average.

The Obesity Vaccine
Rimonabant is one of dozens of drugs being studied. But medications that target the stomach may also be helpful, says Dr. Oz. "I think the best drugs will be those that work on the hormones in the gut. By the time you're working on the brain, it's a little bit late. The stimulus is already coming from the gut. The best way to influence hunger is to influence the gut's signal to the brain to eat," he says. "That way, you affect all the chemicals in the brain the way they're supposed to be affected."

To that end, researchers are looking at a hormone called ghrelin, scourge of yo-yo dieters. When you diet, your body goes into survival mode and ramps up ghrelin production, which may slow your metabolism, encourage eating and force your body to retain fat.

A team of scientists at the Scripps Research Institute have found that keeping ghrelin from reaching the brain may prevent weight gain. When they injected rats with the so-called obesity vaccine, the rats ate normally but gained less weight and had less body fat than rats that didn't get the vaccine. Of course, the rats weren't on our high-fat, high-calorie diet.

The vaccine is far from being tested on humans, but it would be intended for the seriously overweight, and might have to be taken for life, says Kim Janda, PhD, one of the researchers who developed it.

Drugs are promising, but still, regulating your food intake is complicated, says Dr. Klein, since there are so many pathways involved. And even when the pathways are working, and you eat enough to feel satisfied (not stuffed), there are environmental triggers like the aroma of fresh-baked cookies that may lead you to eat though you're not hungry. "Ultimately, it may take multiple drugs blocking multiple pathways to work," he says.

The Fat-Zapping Laser

Genetics plays a big role in both the amount of fat we have -- and where we have it. "A lot of people, no matter how much they exercise and diet, are going to have those pads on their thighs," says Rox Anderson, MD, professor of dermatology at Harvard Medical School. Right now, the most effective option is liposuction. But it's invasive: The surgeon pokes holes in the skin, inserts a metal cannula and sucks out fat. Then there are risks of complications, infection and scarring.

"The holy grail of the next frontier is to be able to perform what liposuction does without breaking the skin, and to have no downtime," says Robert Weiss, MD, vice president of the American Society for Dermatologic Surgery. Dr. Anderson, a pioneer in medical laser technology, has created a laser that can kill fat cells without harming the skin. With the Free-Electron Laser, light goes through the skin into the fat layer, either killing or decreasing the amount of fat, which is then absorbed by the body. But this is early research; the laser has only been tested on animals. We still don't know how painful treatment would be, how long the effects would last, or potential side effects. Next, Dr. Anderson will begin studies to determine the laser's safety and effectiveness in humans, and how well it will treat conditions like cellulite.

More Novel Ideas
Another novel idea: using electricity to trick the stomach into thinking you're stuffed. Doctors at the Mayo Clinic in Rochester, Minnesota, are working with a company called EnteroMedics on the VBLOC (Vagal Blocking for Obesity Control). VBLOC is inserted laparoscopically and uses electricity to block the vagus nerve, which connects the brain and the stomach. It prevents the stomach from increasing in size when you eat (so you feel full quicker) and keeps it from emptying too quickly (so you feel full longer). The result? You get a bit nauseated when you overeat, and are satisfied with less food. The device turns on and off during the day, and shuts off for a period at night. The results of an international study of 30 people are due in a few months. So far, they look promising enough that a larger final-phase trial is planned for later this year.

It's still unclear how much you could lose with VBLOC, but "the minimum expectation would be to see reductions in excess body weight of at least 10 to 15 percent, similar to what you see with obesity drugs and surgical procedures," says William Sandborn, MD, a professor of Medicine at the Mayo Clinic and one of the researchers working on the device.

Medtronic's Implantable Gastric Stimulator works in a different way. Rather than blocking the stomach, this device, also implanted via surgery, stimulates it. Electrical impulses make the stomach distend, leading to a feeling of fullness. The device has been tested on about 150 patients so far, but after a year it's failed to prove that it leads to serious weight loss.

Incision-less Surgery
The most effective tool for major weight reduction is surgery. But there are risks, even though it's done laparoscopically. "The next revolution, of incision-less, or endoluminal, surgery, may allow someone to leave the hospital the same day and go back to work in a few days," says Philip Schauer, MD, president of the American Society for Bariatric Surgery. With Natural Orifice Transluminal Endoscopic Surgery (NOTES), an endoscope is inserted through the mouth and threaded down to the stomach, where it staples or stitches the stomach to make it smaller. It would be done without any incisions or, possibly, even anesthesia.

"It's potentially a very effective, safe option," says Dr. Schauer. But it's at least three to five years from being tested on humans.

What Really Works Now

Rimonabant may be on its way, but the other breakthroughs are at least a few years away. "Expensive treatments can't be viewed as the ultimate solution," says Thomas A. Wadden, MD, past president of the Obesity Society. "We have to prevent more people from becoming obese." Change your shape by changing your lifestyle. Here's how:

Live the Basics
Open your eyes. The first step in adjusting any behavior is becoming more aware of the habit you want to change, says John Foreyt, PhD, director of nutrition research at Baylor college of Medicine. To do that, follow Foreyt's three-step program: Weigh in daily, record what you eat, and track your exercise.

All exercise counts. "Anything you do is good," says Kelly Brownell, PhD, director of the Rudd Center for Food Policy and Obesity at Yale University. "Is it good to walk down to the end of the driveway and back? If you were just sitting around watching Gilligan's Island, then yeah, it's good."

Slow down. "In our culture, you stagger up to the trough, wolf it down and stagger away," says Walter Willett, MD, professor of epidemiology and nutrition at Harvard School of Public health. "Instead, think about what you're eating and enjoy it, bite by bite."

Treat yourself better. Would you give someone else what you feed yourself? Most people, says Dr. Oz, "if they look at it honestly, say, 'No, I'd never let anyone eat that crap. But I'm doing it, and too much of it.' "

Plan to fail. Most of us make rules when we go on a diet. And if we break a rule, the diet's off, says Brownell. Instead, know that you'll make mistakes and know how to pick yourself up.

Carry an "umbrella." "When the climate is foul, we take responsibility for defending ourselves against it," says Yale University obesity expert David Katz, MD. "We live in a foul nutritional climate. People go out in it every day hoping not to get fat. It's silly." So Katz never leaves Home without bringing along whole-grain cereal, carrots, nuts, seeds, fruit and nonfat yogurt.

Make Smart Decisions

Order the starters. Begin meals with a broth-based soup or low-fat salad of no more than 150 calories, and you'll eat less of the main course, says Barbara Rolls, PhD, the Guthrie Chair of nutritional sciences at Penn State. These foods are low in calories, but high in protein, fiber and filling vegetables.

Put out the fire. Reduce trans and saturated fats and processed foods, which stimulate inflammation in the liver and contribute to Diabetes, high cholesterol and hypertension, says Dr. Oz. Eat more natural foods and inflammation-quenching omega-3 fats.

Drink up. Studies show that for some it's easier to lose and maintain weight with meal replacements, such as Slim-Fast or Ensure, than trying to estimate the calories in meals.

Avoid long labels. "Eat a lot of foods with one ingredient," says Katz. "A banana's only ingredient is banana." When buying products in a bag, box, bottle or jar, it's usually good to look for short lists on the labels.

Eat naked. Load up on fruits and veggies, but make sure they're not covered in fat, salt or sugar. And pick unsalted, raw (not roasted) nuts.

Cut the fat. Protein and carbs have four calories per gram. Fat has nine. "When you eat less fat, you consume fewer calories without eating less," says Dean Ornish, MD, founder of the Preventive Medicine Research Institute in Sausalito, California.

Go whole grain. Refined carbs (white rice, pasta, bread) are quickly absorbed and converted into fat, so choose whole grains instead.

Get wet. Eating food with high water content, like broth-based soup, fills you up more than sipping water with your food.

Use the 2/100 rule. Eat fiber-rich foods to reduce the number of calories it takes to feel full, says Katz. Choose bread, cereal and crackers with at least two grams of fiber per 100 calories.

Dump liquid calories. Cut calories in a cup, says Barry Popkin, PhD, director of the Interdisciplinary Center for Obesity at the University of North Carolina at Chapel Hill. "From 1965 to 2002, the average American added 227 calories a day to his diet from beverages." Cut out one soda a day, and you can drop about 13 pounds in a year.

How and When to Eat

Start early. Eating breakfast is key, says James O. Hill, PhD, cofounder of the National Weight Control Registry (NWCR), which tracks people who have lost more than 30 pounds and kept it off. "It makes you better able to manage food during the rest of the day," he says. But what you eat still matters: You can't start your day with doughnuts and expect to lose.

Eat more often. You should never feel starved, says Dr. Oz, who eats small meals every two hours or so. If you eat often, and pick healthy foods, you'll feel full longer.

Find your favorites. Choose a few healthy foods that you enjoy, and stick with them. Have high-fiber cereal for breakfast, and black bean soup with a whole-wheat roll for lunch a few days a week. "Then you eat because you're hungry -- not because you want to taste new tastes," says Dr. Oz.

Watch the weekends. Popkin found that adults ages 19 to 50 eat an extra 115 calories per weekend day. That's Friday, Saturday and Sunday.

You're in Charge
It's what, not how, you lose "There are many ways to lose weight," says Hill. It doesn't matter how you do it, as long as you get the nutrients you need. The key is keeping it off. People in the NWCR do this by staying active and weighing in often.

Take charge. We want to feel in control of what we eat, says Dr. Ornish. "That goes back to the first dietary intervention, when God said not to eat the apple. It didn't work -- and that was God talking." The fix? "Instead of saying, 'These are forbidden foods,' say, 'I'm going to eat healthier. If I indulge one day, it doesn't mean I've failed. It means I'll eat healthier the next.' "'